Use of high-flow nasal cannula oxygen therapy for patients with terminal cancer at the end of life

Q: What question does the study address about HFNC use in terminal cancer?

It identifies how HFNC is used in the last weeks of life and which clinical factors are associated with its initiation timing.

Q: How were patients selected and grouped in the study?

Patients with cancer who died between 2018 and 2020 and initiated HFNC within 14 days before death were included and categorized as imminent (<4 days) or non-imminent (≥4 days).

Q: Which factors were independently associated with imminent HFNC use?

Female sex, no palliative care consultation, no advance statements on life-sustaining treatment in person, and no resting dyspnea were independently associated with imminent HFNC initiation.

Sep 24, 2026

Uploaded by Maya Linwood

Background: Few studies address high-flow nasal cannula (HFNC) use during the last weeks of life. Objective identification of HFNC status and associated clinical factors in end-of-life cancer patients. Methods: A single-center retrospective cohort study at a tertiary hospital in the Republic of Korea included patients with cancer who died between 2018 and 2020, initiating HFNC within 14 days before death. Patients were grouped as imminent (<4 days) versus non-imminent (≥4 days) use. Results and conclusions report timing patterns and factors linked to imminent HFNC initiation.

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CategoryHealthcare

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DOI: 10. 1002/cam4 .6060 RESEAR CH ARTICLE Use of high-flow nasal cannula oxygen therapy for patients with terminal cancer at the end of life Jung Sun Kim1 | Jeongmi Shin2 | Nam Hee Kim3 | Sun Young Lee2,4 | Shin Hye Yoo3 | Bhumsuk Keam5 | Dae Seog Heo6 1Department of Internal Medicine, Chungnam National University Sejong Hospital, Sejong, Korea 2Public Healthcare Center, Seoul National University Hospital, Seoul, Korea 3Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea 4Department of Medicine, Seoul National University College of Medicine, Seoul, Korea 5Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea 6Patient-Centered Clinical Research Coordinating Center, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea Correspondence Shin Hye Yoo, Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Email: [ifi1024@gmail.com](ifi1024@gmail.com) Abstract Background: Few studies have focused on high-flow nasal cannula (HFNC) usage in the last few weeks of life. The aim of this study was to identify the status of HFNC use in patients with cancer at the end of life and the relevant clinical factors. Methods: We performed a retrospective cohort study in a tertiary hospital in the Republic of Korea. Among patients with cancer who died between 2018 and 2020, those who initiated HFNC within 14 days before death were included. Patients were categorized based on the time from HFNC initiation to death as imminent (<4days) and non-imminent (≥4days) . Results: Among the 2191 deceased patients with terminal cancer, 329 (15.0%) were analyzed. The median age of the patients was 66 years, and 62.9% were male. The leading cause of respiratory failure was pneumonia (70.2%), followed by pleural effusion (30.7%) and aggravation of lung neoplasms (18.8%) . Most patients were conscious (79.3%) and had resting dyspnea (76.3%) at HFNC initiation. Patients received HFNC therapy for a mean of 3.4 days in the last 2 weeks of life, and 62.6% initiated it within 4 days before death. Furthermore, female sex, no palliative care consultation, no advance statements in person on life-sustaining treatment, and no resting dyspnea were independently associated with the imminent use of HFNC. Conclusions: Many patients with cancer started HFNC therapy at the point of imminent death. However, efforts toward goal-directed use of HFNC at the endof-life stage are required. KEYWORDS end-of-life, high-flow nasal cannula, nasal cannula, neoplasm, oxygen inhalation therapy, retrospective study Jung Sun Kim and Jeongmi Shin contributed equally. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. KIM et al. | 14613 1 | INTRODUCTION Dyspnea is a prevalent symptom that 10%–70% of patients with cancer experience near death.1,2 Despite the advances in unraveling the pathophysiology and diagnostic workup of dyspnea, those in treatment are unparalleled.3 Thus, dyspnea still bothers patients with advanced cancer and remains a challenge for physicians.4 To date, pharmacologic agents, such as opioids, and non-pharmacological approaches, such as oxygen therapy, are widely used to manage dyspnea.3 In patients with advanced cancer, an initial approach with non-pharmacologic methods and treatment of underlying causes is recommended.5 However, oxygen therapy is narrowly recommended for patients with hypoxemic dyspnea.5 Conventional oxygen therapy uses a nasal cannula or facial mask to deliver low oxygen flow. Additionally, noninvasive ventilation improved gas exchange, but tolerance was poor due to synchronizing difficulty, claustrophobia, and distinctive

FAQs

What question does the study address about HFNC use in terminal cancer?

It identifies how HFNC is used in the last weeks of life and which clinical factors are associated with its initiation timing.

How were patients selected and grouped in the study?

Patients with cancer who died between 2018 and 2020 and initiated HFNC within 14 days before death were included and categorized as imminent (<4 days) or non-imminent (≥4 days).

Which factors were independently associated with imminent HFNC use?

Female sex, no palliative care consultation, no advance statements on life-sustaining treatment in person, and no resting dyspnea were independently associated with imminent HFNC initiation.

Sep 24, 2026

Uploaded by Maya Linwood